Flashcards in EXAM #2: THE DIABETIC FOOT Deck (27):
What are the signs of PVD in the DM patient?
2) Rest pain
3) Atrophic, shiney skin
4) Diminished hair growth
5) Dependent rubor
6) Pallor on elevation
How is the ABI determined?
Lower extremity systolic/ Brachial a. systolic pressure
What is a normal ABI?
Greater than 0.9
What ABI is indicative of severe obstruction?
0.5 or less
What can lead to abnormally elevated ABIs in DM patients?
What is the normal doppler waveform?
How does the doppler waveform change with worsening PVD?
Waves are lost; with severe disease the waveform is monophasic with loss of peak height
What does transcutaneous oxygen pressure measure? Why is this important?
Partial oxygen tension on the skin surface
*Provides important information about healing potential
If a patient has an abnormal non-invasive exam for PVD, what should you do?
What is Charcot Arthropathy?
Neurogenic arthropathy i.e. a progressive degeneration of a weight bearing joint; marked by:
- bony destruction
- bone resorption
- eventual deformity.
What are the three stages of Charcot Arthropathy?
Stage 1= Developmental (acute destructive)
Stage 2= Coalescence
- Healing begins
Stage 3= Reconstruction/ remodeling
How is Charcot Arthropathy treated?
1) Non-weight bearing (take precautions in opposite limb)
2) Cast/ immobilization
3) Serial x-rays
4) Address blood glucose and HbA1c
Where is the most common location for Charcot Arthropathy?
What is the physiologic basis for a chronic wound?
- Increased proteases and MMPs
- Decreased growth factors
What is a Grade 0 wound?
No evidence of ulcer of infection
What is a Grade 1 wound?
What is a Grade 2 wound?
Deep ulcer that may expose tendon
What is a Grade 3 wound?
Deep ulceration with visible bone
What is a Grade 4 wound?
Gangrene of the forefoot
What is a Grade 5 wound?
Gangrene of the entire foot
What do you need to keep in mind about DM patients and infections of ulcers?
Do not present with classic sx. of infection
If a patient has an open ulcer, what should you do?
Take a deep swab or deep tissue culture
If a patient has a possible bone infection, what should you do?
Bone biopsy with histopathology and culture/sensitivity
What is the first image that should be obtained in possible osteomyelitis?
*Will show area of radiolucency
What is a Tc-99m scan? What does it evaluate for?
Standard bone scan that looks at bone turnover
What is the drawback to a Tc-99m scan?
Sensitive but not specific